Drs. Cady and Ryan Brown
In any industry, the relentless setting of higher quotas and a steadily increasing workload can lead to stress, burnout and diminishing returns. Ryan Brown, M.D., and Cady Brown, M.D., were both feeling the strain of caring for too many patients without adequate time to offer the individualized attention they felt each person deserves. So, they decided to go old-school with their internal medicine practice by establishing Downtown Drs. Brown, a small, independently owned practice with the modern twist of membership-based concierge medicine.
“It is daunting to hang out your own shingle, but it can be done,” Ryan Brown said. “It’s hard for primary care to get by in a small two-doc practice without doing something outside of insurance. That’s where the membership fee comes into play.”
Downtown Drs. Brown opened in September 2018 on the ground floor of 535 W. Second St. in downtown Lexington. Membership fees are paid monthly or annually, with some variation for age and individual versus couple; the average price is around $2,400 a year.
The practice also accepts insurance. In return, patients at Downtown Drs. Brown get a 90-minute physical that includes exams, an individualized health plan for the year with goals and accountability, and “time to talk about nutrition, exercise, mental health, sleep and relationships,” Cady Brown said. “These things are so important, but there’s no insurance code for them.”
Patient members also receive monthly emails and have direct communication access with the doctors, and an informed advocate for their health and well-being should they be admitted to a hospital.
“It costs more, so it’s not for everybody,” Ryan Brown said. “If a patient is willing to pay more, they can get off that assembly line type approach to medicine and get personalized, customized care.”
“If a patient is willing to pay more, they can get off that assembly line type approach to medicine and get personalized, customized care.” —Dr. Ryan Brown
During the Browns’ eight-year medical training period between 2007 and 2015, the entire industry of medicine changed, they say. Insurance reimbursements got tighter and lower, hospitals started buying up small practices and patients’ health charts went from paper to digital with the advent of electronic medical records. “When I went to med school, primary care docs all owned their own practices,” Ryan Brown said. “Eight years later, when I finished a chief residency, none of them did except for Family Practice Associates locally.”
“Hospitals are not the bad guys,” Cady Brown adds. “We have nothing against the hospitals that own these practices. They are actually taking on a loss.”
Most graduating physicians are becoming specialists or hospitalists. For those who do choose primary care, “you’re going to see 30 patients a day, and you’re going to have several thousand people to take care of in a year,” Ryan said. “Fewer people are going into it.”
The Browns met in med school at the University of Kentucky, graduated in 2011 and did their residencies at Tulane University in New Orleans for three years and spent another year as two of five chief residents, an academic-leaning position of educating doctors. “Part of the reason I wanted to do the chief year was to see if I wanted to stay in academics,” Cady Brown said. “I’m so glad we had that year, because it really clarified for me that I really liked seeing my own patients.”
A native Lexingtonian, she majored in east Asian history at Davidson College, near Charlotte, North Carolina, where she took a public health class and then studied abroad in China. She was particularly interested in the way practitioners interacted with patients there. After earning her undergrad degree, she got a job at UK with the Kentucky Women’s Health Registry and then applied to med school at UK.
Ryan Brown, from Henderson, Kentucky, majored in psychology at the University of California, San Diego. He took a couple of years’ worth of premed classes at the University of Georgia before going to the UK College of Medicine.
After med school and residency, the husband-and-wife doctors took jobs at a small internal medicine practice in Lexington and began with zero patients. Two and a half years in, Dr. Cady Brown was seeing more than 1,800 patients, and Dr. Ryan Brown had more than 1,600 patients per year. They looked into alternatives and discovered membership medicine, a business model that started in the late 1990s in Seattle and south Florida about the same time.
“It was a gamble on our end to go out and start something from scratch, but we felt comfortable about the model,” Ryan Brown said. “For me, it really wasn’t a choice. I was on the fast track to burning out.”
Drs. Ryan and Cady Brown, center, with Director of Patient Experience Davis Meyer, left, and nurse Anne Christian, right.
Now capping their practice at a few hundred patients instead of thousands, the physicians work with one part-time and two full-time employees at Downtown Drs. Brown. The open and spacious office has three exam rooms, original art, an overall welcoming décor and a lobby where patients can grab fresh vegetables from the Browns’ garden. There’s not a white lab coat in sight.
Two of the exam rooms have large windows and living plants. “We are all meant to be outside anyway,” Cady Brown said. “Plants give off oxygen; we give off carbon dioxide and they use it. That’s a great relationship.”
In their respective business offices, Ryan Brown handles insurance billing and logistics, while Cady Brown deals with insurance requirements, workers’ comp, benefits and other business matters.
Every other month the Downtown Drs. Brown bring in salads from Stella’s Kentucky Deli and a guest speaker for a “lunch and learn” for their patients, and on alternating months they offer a two-mile “walk with your doctors” outing.
With their self-described upbeat philosophy, the Downtown Drs. Brown have a list of top 10 beliefs on their website (downtowndrsbrown.com) that include “Doctoring is about sickness and wellness, physical and mental health” and “A happy doctor is a better doctor.”
During their residency program at Tulane, the Browns were torn between staying in New Orleans, a city they’d grown to love, or going home to Kentucky. “We agonized over that decision,” Cady Brown said. “Once we decided, we’ve had no regrets. This feels like our community and our place. There is just something that feels good about taking care of people in a community that you care about.”
Her husband agreed. “We know this is permanent. This is our community.”